Safinamide
[(S)-2-[4-(3-fluorobenzyloxy)benzylamino]propanamide]
is an oral α-aminoamide derivative developed for the treatment of Parkinson’s
disease (PD). It is a potent, highly selective and reversible inhibitor of
monoamine oxidase B (MAO-B) and reduces dopamine reuptake {dopaminergic
properties}. It also blocks voltage dependent sodium channels by preferentially
interacting with the inactivated channel, modulates N-type calcium channels and
reduces glutamate release {non-dopaminergic properties}. Thus, this unique
combination of two modes of actions offers the potential of a symptomatic
relief of motor features in PD patients in one drug [1-3].
The
activity of drug has been credited to presence of both dopaminergic properties and
non-dopaminergic properties, though the exact use of this activity-combination
is still unknown. Still, Safinamide is considered as a potent addition to the
arsenal answering the unmet needs for treating PD, and related conditions.
Safinamide: 2D and 3D Structutre |
Safinamide
is a small, water-soluble molecule, which is chemically and metabolically
stable. It combines low CNS toxicity, excellent bioavailability, linear
kinetics and a long half-life. Its favorable pharmacokinetics and pharmacodynamics makes it possible for a once-daily oral dosing.
In
February 2015, Safinamide was approved in the EU for the treatment of mid- to
late-stage fluctuating PD, as an add-on to Levodopa (L-dopa), alone or in
combination with other PD medications. The approval is applicable to the EU
member states, as well as Iceland, Lichtenstein and Norway; regulatory
submissions have also been filed in the USA and Switzerland for its use in this
indication.
Parkinson’s disease (PD) and Treatments:
After Alzheimer’s
disease (AD), Parkinson’s disease (PD) is one of the most common neurodegenerative
disease faced by the elderly. PD is characterized by the classically defined
motor symptoms of tremor, bradykinesia, rigidity and postural instability. Various
non-motor symptoms (NMS) that may proceed (e.g., constipation, hyposmia, rapid
eye movement sleep behavioral disorder) or accompany (cognitive, sweating,
sleep disturbances) motor symptoms or may occur at later stages of the disease
(autonomic disturbances). Though PD itself is not life threatening but NMS can
cause fatal injuries [2].
The
exact pathophysiology of PD is unclear, but it is well known that in PD, the
neurodegeneration is widespread. The degeneration of substantia nigra
dopaminergic (DA) neurons causes motor symptoms, while NMS results from loss of
cells with various neurotransmitters. Moreover, there is accumulation of an
insoluble protein α-synuclein in the area involved; forming Lewy bodies which
may lead to cell damage. The damage seems to be enhanced by other mechanisms
such as proteosomal and lysosomal system dysfunction, reduced mitochondrial
activity, inflammation, glutamate excitotoxicity and oxidative stress.
In simple word: In patients with
Parkinson’s disease, certain cells in the brain that produce dopamine die, and
as dopamine is involved in controlling movement, the patient's movement worsens
over time. The treatment of the disease is mainly symptomatic.
As the
motor symptoms and many NMS result from the loss of dopaminergic neurons,
dopamine replacement forms the cornerstone of therapy.
Dopamine
is a monoamine neurotransmitter and human body synthesize it via the food we
intake. Tyrosine which is available in our diet is converted to Levodopa which
is decarboxylated to dopamine in the neurons. Once the dopamine is released
into the synaptic cleft, it is metabolized by monoamine-oxidase B (MAO-B)
enzyme and in the postsynaptic neurons by catechol-O-methyl transferase (COMT).
Thus, dopaminergic replacement drugs include Levodopa (most commonly used drug
to treat PD), dopamine agonists (DAs, such as Bromocriptine, Lisuride, Pramipexole,
Ropinirole, etc) and drugs preventing dopamine metabolism – peripheral COMT
inhibitors (COMTIs, such as Tolcapone and Entacapone) and MAO-B inhibitors
(MAO-BIs, such as Selegiline, Rasagiline, and now Safinamide).
Levodopa
and DA therapy though very effective are marred with serious adverse events
including increased dyskinesias, gastrointestinal and sleep/fatigue-related
adverse events. Compared with Levodopa and DA therapy, MAO-BIs have weaker
symptomatic benefit but lesser side effects. This makes them perfect candidate for
monotherapy in early stages and as adjunctive to Levodopa in later stages of
the disease [4].
Mechanism of Action in Safinamide:
Safinamide
is a selective and reversible inhibitor of monoamine oxidase-B (MAO-B) and
blocks dopamine reuptake. Monoamino oxidases (MAOs) are flavin adenine
dinucleotide (FAD) containing enzymes localized in the outer mitochondrial
membrane. MAOs are involved in the oxidative deamination of important endogenous
amines, including monoamine neurotransmitters serotonin (5-HT), norepinephrine
(NE), and dopamine (DA), as well as exogenous amines, comprising the hypertensive
dietary amine tyramine [3,4].
Two
different isoenzymatic forms have been identified, namely, MAO-A and MAOB, which
differ in their amino acid sequences, three-dimensional structures and
substrate specificity and sensitivity to inhibitors. MAO-A preferentially
deaminates noradrenaline and serotonin while MAO-B shows affinity for
benzylamine and phenylethylamine. Monoamines, for example, dopamine, are
substrates of both isoforms.
Reversible
inhibitors of MAO-A are an effective treatment approach for depression.
Selective inhibitors of MAO-B are used for the treatment of PD patients, since
they prolong dopamine activity in the synaptic cleft of dopaminergic neurons.
They are used in addition to Levodopa either alone or in combination with other
medicines for Parkinson’s, in patients with mid- to late-stage Parkinson’s
disease who are having ‘motor fluctuations’. These fluctuations occur when the
effect of Levodopa wears off and the patient suddenly switches from being ‘on’
and able to move about to being ‘off’ and having difficulty moving about [5].
Other Activities:
Antiglutamate
effect:
Safinamide blocks voltage-dependent fast sodium channels. It has a prefential
interaction with the inactivated sodium channel and prevents its recovery to
the active state. Safinamide also modulates N-type calcium channels. Both
mechanisms have been considered to reduce glutamate release and NMDA receptor
stimulation. The inhibition of glutamate can reduce dyskinesias similar to drug
amantadine and protect against excitotoxicity.
Neuroprotective
effects:
As common with all other MAO-BIs, Safinamide has shown neuroprotective effects
in animal and tissue culture models.
Dose-related
improvement in motor symptoms on using Safinamide have been postulated to its
combined ability for inhibition of glutamate release, increased dopamine
release and inhibition of reuptake of dopamine.
Dosages and Approvals:
Safinamide
(Tradename:
Xadago) is indicated for the treatment of adult patients with
idiopathic Parkinson's disease (PD) as add-on therapy to a stable dose of
Levodopa (L-dopa) alone or in combination with other PD medicinal products in
mid-to late-stage fluctuating patients. Treatment with Safinamide should be
started at 50 mg per day. This daily dose may be increased to 100 mg/day on the
basis of individual clinical need [6].
Safinamide
may be taken with or without food.
Safinamide
use in patients with severe hepatic impairment is contraindicated. No dose
adjustment is required in patients with mild hepatic impairment. The lower dose
of 50 mg/day is recommended for patients with moderate hepatic impairment. If
patients progress from moderate to severe hepatic impairment Safinamide should
be stopped.
Safinamide
was discovered by Farmitalia Carlo Erba, later taken over by Pharmacia and UpJohn
(P and U). P and U took Safinamide to Phase I trials with potential treatment for
epilepsy. At the end of 1998, Newron Pharmaceuticals acquired the rights and
intellectual property from Pharmacia Corporation. In 2004, Newron initiated
Phase III trials of Safinamide for treating Parkinson's disease, and in 2006
Newron signs global development and commercialisation agreement for Safinamide
with Merck Serono. In 2011, Merck Serono backed out of the deal and transferred
all rights to Newron.
Since
2012, Newron is in strategic collaboration and licence agreement with Zambon
for the worldwide development and commercialization of Safinamide (excluding
Japan and key Asian territories) and with Meiji Seika Pharma, under which Meiji
Seika acquired the rights to develop and commercialize Safinamide in Japan and
key Asian territories.
Reported Activities for Safinamide:
Safinamide
(S-enantiomer) is a highly selective and reversible inhibitor of MAO-B (IC50
rat MAO-B = 0.098 uM) enzyme with minimal effect on MAO-A enzyme (IC50
rat MAO-A = 580 uM) and increases the level of endogenous and exogenous
dopamine. Almost complete inhibition of MAO-B is achieved with a dose of 0.3
mg/kg of safinamide in humans. The selectivity of safinamide for MAO-B is so
high that even at doses of 10 mg/kg, no inhibition of MAO-A was observed.
IC50
(Inhibition of rat MAO-B activity) = 0.098 uM
IC50
(Inhibition of rat MAO-A activity) = 580 uM
Selectivity
Index (ratio of IC50 value of MAO-A by that of MAO-B) = 5918
R enantiomer has the following activities:
IC50
(Inhibition of rat MAO-B activity) = 0.45 uM
IC50
(Inhibition of rat MAO-A activity) = 42 uM
Selectivity
Index (ratio of IC50 value of MAO-A by that of MAO-B) = 93
Summary
Common name: EMD 1195686; FCE
26743; ME2125; NW 1015; PNU 151774; PNU 151774E; Safinamide; Safinamide
mesilate; Safinamide mesylate
Trademarks: Xadago
Molecular Formula: C17H19FN26O2
CAS Registry Number: 133865-89-1; 202825-46-5
(mesylate)
CAS Name: (S)-2-((4-((3-fluorobenzyl)oxy)benzyl)amino)propanamide
Molecular Weight: 302.34
SMILES: C[C@H](NCC1=CC=C(OCC2=CC=CC(F)=C2)C=C1)C(N)=O
InChI Key: NEMGRZFTLSKBAP-LBPRGKRZSA-N
InChI: InChI=1S/C17H19FN2O2/c1-12(17(19)21)20-10-13-5-7-16(8-6-13)22-11-14-3-2-4-15(18)9-14/h2-9,12,20H,10-11H2,1H3,(H2,19,21)/t12-/m0/s1
Mechanism of Action: Monoamine Oxidase-B Inhibitor;
Dopamine Uptake Inhibitor; Glutamate Release Inhibitor; Calcium Channel Antagonist;
Sodium Channel Antagonist
Activity: Treatment of Parkinson’s Disease; Antiepileptics;
Dopaminergic Agents; Nervous System Drugs; Anti-Parkinson Drugs
Status: Launched 2016 (EU)
Chemical Class: Small molecules; Flourine
containing; Amides, Benzylamines; Ether containing; Fluorobenzenes; L-Alaninamide
derivative
Originator: Farmitalia Carlo Erba / Newron Pharmaceuticals